Dysphagia, or swallowing disorder, is a general term used to describe the inability to move food from the mouth to the stomach. Some patients have limited awareness of their dysphagia, so lack of the symptom does not exclude an underlying disease or condition. When dysphagia goes undiagnosed or untreated, patients are at a high risk of pulmonary aspiration and subsequent aspiration pneumonia secondary to food or liquids going the wrong way into the lungs. Some people present with “silent aspiration” and do not cough or show outward signs of aspiration. Undiagnosed dysphagia also can result in dehydration, malnutrition, renal failure, and repeated episodes of aspiration pneumonia.
Swallowing disorders can occur in all age groups, resulting from congenital abnormalities, structural damage, and/or medical conditions. Swallowing problems are a common complaint among older individuals, and the incidence of dysphagia is higher in the elderly, in patients who have had strokes, and in patients who are admitted to acute care hospitals or chronic care facilities. Dysphagia is a symptom of many different causes, which can usually be identified through a careful history by the treating physician. A formal oropharyngeal dysphagia evaluation is performed by a speech language pathologist.
The goals of treatment are to maintain adequate nutritional and hydrational intake and to maximize airway protection. Rehabilitation therapy is the main stay of dysphagia management and allows for safe swallowing. Rehabilitation requires the cooperation of the patient and the ability of the patient to understand and follow commands. Typical therapy programs involve oral feeding with consistency modifications, compensatory strategies to reduce the risk of aspiration, strengthening therapy to increase muscle tone and augment oropharyngeal swallow, and medical therapies.
One condition related to dysphagia is obstructive sleep apnea. (See Valbuza et al., Swallowing dysfunction related to obstructive sleep apnea: a nasal fibroscopy pilot study, Sleep Breath 15(2):209-13 (2011)). Obstructive sleep apnea (OSA) is the most common category of sleep-disordered breathing. The muscle tone of the body ordinarily relaxes during sleep, and at the level of the throat the human airway is composed of collapsible walls of soft tissue which can obstruct breathing during sleep. Mild occasional sleep apnea, such as many people experience during an upper respiratory infection, may not be important, but chronic severe obstructive sleep apnea requires treatment to prevent low blood oxygen (hypoxemia), sleep deprivation, and other complications. Individuals with low muscle tone and soft tissue around the airway (e.g., because of obesity) and structural features that give rise to a narrowed airway are at high risk for obstructive sleep apnea. The elderly are more likely to have OSA than young people. Men are more likely to suffer sleep apnea than women and children.
Additional therapies are needed to assess and improve swallowing function, speech, and breathing functions.